The concepts of gene therapy were initially introduced during the 1960s. Since the early 1990s, more than 1900 clinical trials have been conducted for the treatment of genetic diseases and cancers mainly using viral vectors. Although a variety of methods have also been performed for the treatment of malignant gliomas, it has been difficult to target invasive glioma cells. To overcome this problem, immortalized neural stem cell (NSC) and a nonlytic, amphotropic retroviral replicating vector (RRV) have attracted attention for gene delivery to invasive glioma. Recently, genome editing technology targeting insertions at site-specific locations has advanced; in particular, the clustered regularly interspaced palindromic repeats/CRISPR-associated-9 (CRISPR/Cas9) has been developed. Since 2015, more than 30 clinical trials have been conducted using genome editing technologies, and the results have shown the potential to achieve positive patient outcomes. Gene therapy using CRISPR technologies for the treatment of a wide range of diseases is expected to continuously advance well into the future.

Anterior cervical foraminotomy (ACF) is a surgical procedure for cervical radiculopathy to avoid fusion and adjacent segment disease (ASD), but its long-term outcome has yet to be investigated. It is also unclear whether ACF enables preservation of range of motion (ROM) and decreases ASD compared with anterior cervical discectomy and fusion (ACDF). This study included nine patients who underwent ACF, and 12 who underwent ACDF and with follow-up period of at least 5 years (average follow-up: 8.7 years). Preoperative and postoperative radiological findings were investigated, comparing the changes in ACF versus ACDF. All disc height (DH) levels (C2/3-C7/Th1) were measured preoperatively and postoperatively in all 21 patients to compare with the change due to the natural history. The ACF group experienced significant loss of DH (0.6 mm, 13.5%, p <0.01) and ROM (p <0.01) at the operated level postoperatively. However, loss of DH was not significantly different from natural changes at unaffected levels, and ROM was maintained. The ACDF group experienced a significant increase in the ROM of the cranial adjacent segment from 6.46 mm to 7.45 mm (p <0.01), and the dislocation in dynamic X-ray was also significantly increased from 1.61 mm to 2.89 mm (p <0.01), indicating radiological ASD. The ACF group had no significant increase in ROM and dislocation. ACF causes significant loss of DH and ROM, but this change is not significantly different compared with natural changes at unaffected levels. Furthermore, ACF causes less ASD than ACDF in the long term.

Carotid artery stenting (CAS) is performed as a treatment for carotid artery stenosis. However, lipid-rich plaques cause embolic complications and sequelae. Near-infrared spectroscopy (NIRS) can identify lipid components by applying a near-infrared absorption pattern, and the distribution of lipid components can be evaluated as the maximum lipid core burden index (maxLCBI). Intravascular ultrasound (IVUS) equipped with NIRS has been clinically applied recently, and its diagnostic usefulness and validation have been reported for coronary arteries; however, its consistency with actual pathological diagnosis in carotid artery lesions has not been validated. In this study, we investigated the consistency between the maxLCBI values and histopathological diagnoses. Patients with cervical carotid artery stenosis who underwent carotid endarterectomy (CEA) were examined in this prospective study. Pathological diagnosis was determined after NIRS evaluation, which was performed on the extracted plaques ex vivo. The histological slices of decalcified and paraffin-embedded sections were stained by hematoxylin–eosin (HE) and Elastica van Gieson (EVG), and for low-density lipoprotein (LDL), C-reactive protein (CRP), CD68, and glycophorin A. The correlation between maxLCBI values and histological findings. Seventy lesions assessed by NIRS were pathologically analyzed. There was a positive linear correlation between maxLCBI values and pathological findings as determined by HE (angle), HE (area%), EVG, CRP, and CD68 staining (respectively, r = 0.624, p <0.001; r = 0.578, p <0.001; r = 0.534, p <0.001; r = 0.723, p <0.001; r = 0.653, p <0.001). In conclusion, the maxLCBI values assessed by NIRS showed a significant positive linear correlation with pathological evaluations in carotid lesions. The maxLCBI values in carotid arteries are consistent with pathological evaluations.

Prognosis for patients with acute basilar artery occlusion (BAO) remains poor. Successful revascularization is a main predictor of favorable clinical outcomes after mechanical thrombectomy for BAO. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome, including vegetative state and mortality. This study investigated the factors that are predictive of extremely poor clinical outcomes despite successful revascularization after mechanical thrombectomy for BAO. We evaluated 35 consecutive patients who presented with acute ischemic stroke due to BAO and who were successfully treated with mechanical thrombectomy. A very poor outcome was defined as a modified Rankin Scale (mRS) score of 5 or 6 at 3 months after treatment. The associations between the clinical, imaging, procedural factors, and poor outcome were evaluated. Using univariate analyses, there were significant differences in the preoperative National Institute of Health Stroke Scale (NIHSS) score (22.0 ± 9.0 vs. 30.5 ± 4.3, p <0.001), and infarct volume in brain stem (0.11 ± 0.19 cc vs. 2.55 ± 1.56 cc, p <0.001) between the control and very poor outcome groups. In receiver operating characteristic (ROC) curve analysis, the area under ROC curve of infarct volume in brain stem was 0.891 to predict very poor outcome. Preoperative infarct volume in brain stem is strong predictor for very poor outcome. The infarct volume in brain stem is useful for deciding treatment indications.

Skull base reconstruction after an endoscopic endonasal approach into the cerebrospinal fluid (CSF) space is always challenging. Various reconstructive methods are available, but no standard technique is established. This report describes the endoscopic skull base dural closure using a modified nonpenetrating clip device with shaft length of 15 cm. Six patients with an intra-suprasellar or suprasellar tumor who underwent extended endoscopic endonasal transsphenoidal surgery were targeted. For closure of the skull base dural defect after tumor removal, fascia lata was first placed as an inlay graft and was subsequently fixed with the dura using a modified nonpenetrating clip device. No CSF leakage from the closed dura with an inlay fascia lata fixed with clips was confirmed by the Valsalva maneuver. To complete skull base reconstruction, fascia lata was then positioned as an overlay graft and covered with vascularized pedicled nasoseptal flaps. Five of six patients experienced no CSF rhinorrhea postoperatively. The modified nonpenetrating clip device may achieve effective dural closure in the deep and narrow nasal cavity. We introduce this clip device technique as one of the endoscopic skull base dural closure methods.